Margot Andersen, MSW
Introduction
Full disclosure: I have had migraines for 55 years. I progressed from episodic to chronic in my late forties. While I have been on many types of preventive and abortive medications and have tried several complementary and alternative treatments, I have found mindfulness, meditation, gratitude, and other resilience practices to be extremely effective in helping me manage and cope with chronic pain and life’s adverse events.
What Is Mindfulness?
ANDERSEN:
Mindfulness is the intention to pay attention fully to something in the present moment with a kind, non-judgmental attitude. In mindfulness, the object of our attention is often our breath coming in and out of our body, a candle that is burning in front of you or some other event that is occurring now. Mindfulness practice brings the present moment into sharp focus, so the mind is not ruminating on the past or worrying about the future.
How Does Mindfulness Affect Migraine Disease?
ANDERSEN:
As attention is brought to breathing, we become cognitively defocused (defused) from our experience of pain. While paying attention to breathing does not alleviate a migraine attack, it can help those with migraine disease cope with the experience of pain. There is no mistaking the primary source of the discomfort and pain: the migraine attack. A myriad of symptoms can accompany a migraine attack, from brain fog, aura, nausea, neck pain, throbbing, and stabbing pain to dizziness, runny nose, and general flu-like symptoms.
Although these are the primary sources of pain, many patients will experience secondary types of pain, such as the emotions of anxiety, depression, catastrophizing, fear, and numerous other thoughts. Many thoughts are the result of experiencing headache and migraine disorders for many years: Will I be able to go to work? Will the pain ruin my plans for today? Will the pain get worse? What will I do if….? What if I can’t do ….? What will my friends/family think if I have to cancel plans again? These secondary forms of pain create the stress response from the hypothalamus-pituitary-adrenal axis (HPA) that aggravate the primary symptoms. These secondary thoughts and emotions excite the sympathetic nervous system to create a fight-flight-freeze response to pain. Animals and sophisticated organisms are hard-wired to flee from and fight pain and aversive stimuli. Hence, it is really difficult to relax while in pain!
Learning various breathing strategies can engage the parasympathetic nervous system. This is the “tend and befriend” part of the nervous system. The vagus nerve can cause the “relaxation response.” This response fights all the fight-flight-freeze chemicals and is an antidote to all the chemicals generated by the pain, thoughts, and emotions of the sympathetic nervous system.
Mindfulness Techniques
ANDERSEN:
There are several different forms of meditation, and there are many mindfulness techniques. Mindful meditation is only one of them. In Open Awareness meditation, you focus on observing your breath and witnessing your thoughts. Imagine your thoughts as the bubbles that children blow. No one thought is of more interest than the subsequent thought. You just notice it and let it go. On to the next thought, and the next. Or, if a thought or emotion arises, it can be noticed and named. For example, “Oh, work thought. Anger thought. Migraine thought. Sad thought. Pain thought. To-do list.” And, so on. The trick is to refuse to allow any thought to engage you. You are simply the witness to the thoughts. It is as if you are sitting in the balcony of a theatre and your thoughts are the characters walking across the stage.
The biggest objection I hear is: “I can’t stop my thoughts.” It’s a good thing we cannot stop our thoughts. We have between 60,000-80,000 thoughts per day. It is the job of the human mind to generate thoughts all day long. Therefore, we use those thoughts as the fodder and food for practicing meditation.
In “box breathing,” you inhale, hold, and exhale. Hold each breath to a count of 3 or 4 (like a box). Or, you can inhale to a count of 3 and exhale to a count of 5. Counting your inhales/exhales is one way to practice breathing. Another technique is to initially set your phone timer to 3 minutes and simply observe your breath and thoughts. Taking a deep diaphragmatic breath with a long exhalation (try 3) is deeply calming.
How Does Meditation Change the Pain Brain?
ANDERSEN:
When the individual experiences pain and the accompanying unpleasant symptoms of a migraine attack, the patient will feel ambushed and engulfed in the pain (or other symptoms). The patient will describe the situation as if a blob has glommed onto their body. Hence, the psychological term that we are “cognitively fused” with our pain. Practicing breathing and mindful meditation helps gain some distance from the pain, affording an “arm’s length” perspective from the pain and thoughts. Remember, you are in the audience in the theatre. The patient is in the process of observing the pain/thoughts, and with greater distance, those secondary thoughts can be challenged. Many of those 60,000 thoughts per day are self-critical. If they are examined, it is apparent that those thoughts are ridiculous and exaggerated.
For example, will your friend really never speak to you again if you cancel plans due to a migraine attack? Will your boyfriend really break up with you if he understands your migraine disease, or will he help you try to manage it? Breathing strategies calm the amygdala in the brain, the fight-flight-freeze center. This allows your hippocampus, a major memory center, to stabilize with the highest part of the brain, the prefrontal cortex. If the amygdala can be calmed, the brain is in a much stronger position to permit the prefrontal cortex to identify and challenge ridiculous thoughts. The psychological term for this is cognitive reframing and cognitive challenge.
Focusing on Breathing Despite the Pain
ANDERSEN:
It is not easy to try to meditate when you are in extreme distress with migraine attack symptoms. The patient should focus on taking one breath, then focus on taking the next breath, and the next breath. One breath at a time. Just one breath. Pain does not stay static, it is impermanent and changes minute by minute. Each deep breath relaxes the body just a little, and then just a little more. To build resilience in this difficult moment, the patient must remember that they have survived terrible pain before, and it has passed. Pain changes, just as there are micro changes when you take your next breath. This is not the time to try to practice a 10-minute meditation. Just breathe one breath at a time, and then one more.
How Do Acceptance and Mindfulness Work Together?
ANDERSEN:
Acceptance plays a big role in mindfulness. There is an axiomatic saying, “That which we resist, persists.” Another way of saying this is that Suffering = Resistance to Reality. Experiencing adversity, illness, loss, and betrayal is part of the human condition. Pain in life is inevitable; Suffering is optional! No one enjoys adverse events in their lives, and we all wish we could live without them. However, to push and resist against what is true, real, and obvious creates personal suffering. By mindfully observing thoughts in a loving and kind way, with no harsh judgment, the ability to accept those events and thoughts will increase. Being angry about an illness is understandable. Squashing that anger, not acknowledging it, will cause more suffering. Mindfulness meditation allows us to view all sides of ourselves, the good, the bad, and the ugly, with acceptance and a non-judgmental attitude. Practicing acceptance of all our feelings, thoughts, and emotions is a daily practice just like mindfulness.
Self-Compassion
ANDERSEN:
Self-compassion is a mindfulness practice. We live in a competitive culture where everyone wants to be the “best.” As a result, our inner dialogue is very harsh and self-critical as we push ourselves to be on top. However, living with a chronic illness like migraine requires an infinite amount of self-love, self-forgiveness, and self-compassion when not feeling well. The patient needs to be extra compassionate with themselves and take good care of their bodies and minds. Self-compassion prevents feeling guilty when loving care is given. Practicing self-compassion is both a mindfulness and acceptance strategy that will help manage headache and migraine triggers and attacks.
Margot Andersen, MSW
Mindfulness Meditation Teacher through the Institute for Jewish Spirituality
RYT (Registered Yoga Instructor)
Board member, National Headache Foundation
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This article was reposted with permission from MDedge.
